An in-depth characterisation of neonatal seizures by early continuous video-EEG analysis

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dc.contributor.advisor Boylan, Geraldine B. en
dc.contributor.advisor Ryan, C. Anthony en
dc.contributor.author Low, Evonne
dc.date.accessioned 2016-12-20T12:44:42Z
dc.date.available 2016-12-20T12:44:42Z
dc.date.issued 2016
dc.date.submitted 2016
dc.identifier.citation Low, E. 2016. An in-depth characterisation of neonatal seizures by early continuous video-EEG analysis. PhD Thesis, University College Cork. en
dc.identifier.endpage 276 en
dc.identifier.uri http://hdl.handle.net/10468/3400
dc.description.abstract Introduction Seizures are harmful to the neonatal brain; this compels many clinicians and researchers to persevere further in optimizing every aspects of managing neonatal seizures. Aims To delineate the seizure profile between non-cooled versus cooled neonates with hypoxic-ischaemic encephalopathy (HIE), in neonates with stroke, the response of seizure burden to phenobarbitone and to quantify the degree of electroclinical dissociation (ECD) of seizures. Methods The multichannel video-EEG was used in this research study as the gold standard to detect seizures, allowing accurate quantification of seizure burden to be ascertained in term neonates. The entire EEG recording for each neonate was independently reviewed by at least 1 experienced neurophysiologist. Data were expressed in medians and interquartile ranges. Linear mixed models results were presented as mean (95% confidence interval); p values <0.05 were deemed as significant. Results Seizure burden in cooled neonates was lower than in non-cooled neonates [60(39-224) vs 203(141-406) minutes; p=0.027]. Seizure burden was reduced in cooled neonates with moderate HIE [49(26-89) vs 162(97-262) minutes; p=0.020] when compared with severe HIE. In neonates with stroke, the background pattern showed suppression over the infarcted side and seizures demonstrated a characteristic pattern. Compared with 10 mg/kg, phenobarbitone doses at 20 mg/kg reduced seizure burden (p=0.004). Seizure burden was reduced within 1 hour of phenobarbitone administration [mean (95% confidence interval): -14(-20 to -8) minutes/hour; p<0.001], but seizures returned to pre-treatment levels within 4 hours (p=0.064). The ECD index in cooled, non-cooled neonates with HIE, stroke and in neonates with other diagnoses were 88%, 94%, 64% and 75% respectively. Conclusions Further research exploring the treatment effects on seizure burden in the neonatal brain is required. A change to our current treatment strategy is warranted as we continue to strive for more effective seizure control, anchored with use of the multichannel EEG as the surveillance tool. en
dc.description.sponsorship Wellcome Trust (Grant 85249/z/08/z) en
dc.format.mimetype application/pdf en
dc.language English en
dc.language.iso en en
dc.publisher University College Cork en
dc.rights © 2016, Evonne Low. en
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/ en
dc.subject EEG en
dc.subject Neonatal seizures en
dc.subject Brain monitoring en
dc.subject Developing neonatal brain en
dc.subject Electroclinical dissociation of seizures en
dc.subject Multi-channel EEG en
dc.subject Neonatal stroke en
dc.subject Phenobarbitone en
dc.subject Seizure burden en
dc.subject Therapeutic hypothermia en
dc.subject Treatment en
dc.title An in-depth characterisation of neonatal seizures by early continuous video-EEG analysis en
dc.type Doctoral thesis en
dc.type.qualificationlevel Doctoral Degree (Structured) en
dc.type.qualificationname PhD (Medicine and Health) en
dc.internal.availability Full text available en
dc.check.info No embargo required en
dc.description.version Accepted Version
dc.contributor.funder Wellcome Trust en
dc.description.status Not peer reviewed en
dc.internal.school Paediatrics and Child Health en
dc.check.type No Embargo Required
dc.check.reason No embargo required en
dc.check.opt-out Not applicable en
dc.thesis.opt-out false
dc.check.embargoformat Not applicable en
ucc.workflow.supervisor g.boylan@ucc.ie
dc.internal.conferring Spring 2016 en


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